Treatment of colonic obstruction with expandable metal stents: radiologic features.
Treatment of colonic obstruction with expandable metal stents: radiologic features.
复制标题
用可扩张金属支架治疗结肠梗阻：放射学特征。
DOI：
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
R. Koehler
中科院分区：
文献类型：
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作者：
C. Canon;T. Baron;D. Morgan;Phillip A. Dean;R. Koehler
目的
本前瞻性研究的目的是评价可膨胀金属支架用于急性恶性梗阻患者结肠减压的有效性，并描述相关的影像学结果。
受试者和方法
在透视和内窥镜引导下，我们在13例急性恶性梗阻患者的结肠内放置了可膨胀金属支架。在4例患者中放置支架，以便在手术切除和一期吻合术之前进行标准肠道清洁。在其他9名患者中，放置支架以缓解不可切除的肿瘤，避免结肠造口术。分析两组的疗效及并发症。对手术计划、支架置入、置入后评估和并发症检测的放射学方面进行了评价。
结果
在成功切除并进行一期吻合术的四名外科候选人中，有两名因支架移位伴复发性梗阻接受了不完全的肠清洗。9名因不可切除肿瘤而放置支架的患者中有8名缓解了急性梗阻。该组的并发症包括2例穿孔，1例需要立即结肠造口术，1例自限性保守治疗。8名患者中有2名出现早期支架阻塞，其中1名需要结肠造口术。另一名患者放置支架以缓解不可切除的肿瘤，但拒绝进一步治疗。造影剂增强灌肠检查被证明是有用的，在评估病变的支架减压的适用性，指导支架类型的选择和最合适的位置，为病人在支架放置。支架置入后，立即进行腹部平片和水溶性造影剂灌肠检查，帮助我们验证支架位置和通畅性。
结论
这些结果表明，在急性恶性结肠梗阻患者中放置可膨胀金属支架是结肠造口术的可行替代方案，并可能降低发病率和死亡率。在进行结肠支架减压术的患者的管理中，支架置入前、期间和之后的放射学评估起着不可或缺的作用。
OBJECTIVE
The purpose of this prospective study was to evaluate the efficacy of expandable metal stents for colonic decompression in patients presenting with acute malignant obstruction and to describe the associated radiographic findings.
SUBJECTS AND METHODS
Using both fluoroscopic and endoscopic guidance, we placed expandable metal stents within the colons of 13 patients presenting with acute malignant obstruction. Stents were placed in four patients to permit a standard bowel cleansing before surgical resection with primary anastomosis. In the other nine patients, stents were placed for palliation of nonresectable tumors, obviating colostomy. Outcomes and complications were analyzed. The radiologic aspects of procedural planning, stent placement, assessment after placement, and detection of complications were evaluated.
RESULTS
Of the four surgical candidates who were successfully resected with primary anastomosis, two received incomplete bowel cleansing because of stent migration with recurrent obstruction. Eight of the nine patients who had stents placed for palliation of nonresectable tumors had relief of acute obstruction. Complications in this group included two perforations, one that required immediate colostomy and one that was self-limited and conservatively treated. Two other patients of the eight developed early stent obstruction, requiring colostomy in one. The other patient who had a stent placed for palliation of a nonresectable tumor declined further treatment. Contrast-enhanced enema examination proved useful in assessing the suitability of lesions for stent decompression, directing the choice of stent type and the most appropriate position for the patient during the stent placement. Immediately after stent placement, plain abdominal radiographs and water-soluble contrast enema examinations helped us verify stent position and patency.
CONCLUSION
These results suggest that placement of expandable metal stents in patients presenting with acute, malignant colonic obstruction is a viable alternative to colostomy and can potentially decrease morbidity and mortality. Radiologic assessment before, during, and after stent placement plays an integral role in the management of patients undergoing stent decompression of the colon.